When staged surgical treatment can solve bilateral axillary and inguinal severe hidradenitis suppurativa Staged surgical treatment for hidradenitis

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Diletta Maria Pierazzi
Sarah Calabrese
Edoardo Pica Alfieri
Gianpaolo Faini


hidradenitis suppurativa, flaps, axillary region reconstruction, inguinal region reconstruction


Hidradenitis suppurativa (HS) is a chronic and debilitating disease that primarily affects the axillary, inguinal and anogenital areas. The treatment requires wide surgical excision of the affected tissue with adequate free margins in order to avoid recurrence. However, axillary and inguinal regions reconstruction after HS excision still represents a big challenge; the large defect can be closed using flaps, which allows more rapid rehabilitation and minimizes the risk of later scar contracture. In this report is discussed our experience with reconstruction of severe bilateral hidradenitis lesions of the axillary and inguinal areas in a young woman. Bilateral thoracodorsal artery perforator flaps were used for the axillary reconstruction while profunda artery perforator flap and direct suture were used respectively for left and right inguinal region.


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1. Shelley WB, Cahn MM. The pathogenesis of hidradenitis suppurativa in man; experimental and histologic observations. AMA Arch Derm 1955;72:562-565.
2. Gulliver W, Zouboulis CC, Prens E, et al. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord 2016;17:343–351.
3. Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2009;23:985-998.
4. Slade DE, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 2003;56:451–461.
5. Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician 2005;72:1547–1552.
6. Bieniek A, Matusiak L, Okulewicz-Gojlik D, et al. Surgical treatment of hidradenitis suppurativa: experiences and recommendations. Dermatol Surg 2010;36:1998–2004.
7. Soldin MG, Tulley P, Kaplan H, et al. Chronic axillary hidradenitis: the efficacy of wide excision and flap coverage. Br J Plast Surg 2000;53:434-436.
8. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Eng J Med 2012;366:158–164.
9. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol 2015;29:619-644.
10. Kagan RJ, Yakuboff KP, Warner P, et al. Surgical treatment of hidradenitis suppurativa: a 10-year experience. Surgery 2005;138:734–740
11. Teo WL, Ong YS, Tan BK. Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa. Arch Plast Surg 2012;39:663-666.
12. Nail-Barthelemya R, Stroumza N, Qassemyara Q, et al. Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis. Ann Chir Plast Esthet 2019;64:68-77.
13. Elgohary H, Hamed AM, Nawar AM et al. Outcome of Pedicled Thoracodorsal Artery Perforator Flap in the Surgical Treatment of Stage II and III Hidradenitis Suppurativa of Axilla. Ann Plast Surg 2018; 81:688–693.
14. Ortiz CL, Castillo VL, Pilarte FS, et al. Experience using the thoracodorsal artery perforator flap in axillary hidradentitis suppurativa cases. Aesth Plast Surg. 2010;34:785–792.
15. Marchesi A, Marcelli S, Zingaretti N, et al. Pedicled Thoracodorsal Artery Perforator and Muscle-Sparing Latissimus Dorsi Flaps in the Axillary Reconstruction After Hidradenitis Suppurativa Excision Functional and Aesthetic Issues Ann Plast Surg 2018;81:694-701.
16. Mericli AF, Martin JP, Campbell CA. An algorithmic anatomical subunit approach to pelvic wound reconstruction. Plast Reconstr Surg. 2016;137:1004–1017.
17. Largo RD, Chu CK, Chang EI, et al. Perforator Mapping of the Profunda Artery Perforator Flap: Anatomy and Clinical Experience. Plast Reconstr Surg 2020 Nov;146:1135-1145.

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